Impact of therapeutic interchange from pravastatin to lovastatin in a veterans affairs medical center

Objective: To evaluate the impact of a therapeutic interchange from pravast atin to lovastatin on treatment outcomes, quality of life, patient satisfac tion, and costs. Study Design: A prospective cohort study of 170 patients switched from prav astatin to lovastatin from September 1997 through November 1997. Patients and Methods: The therapeutic interchange program promoting lovasta tin as the preferred agent went into effect June 2, 1997 after Merck & Co. was awarded the Veterans Health Administration national contract for 3-hydr oxy-3-methylglutaryl coenzyme A reductase inhibitors. Patients were switche d to lovastatin by either their primary care physician during routine clini c visits or the pharmacist by mail. The following outcomes were measured be fore and after conversion to lovastatin: lipid values, liver function tests , National Cholesterol Education Program (NCEP) low-density cholesterol (LD L-C) goals achieved, quality of life (QOL) (measured by the Medical Outcome s Study 36-item short-form health survey [SF-36]), medication tolerance (me asured with a global symptom survey), patient satisfaction, and cost-minimi zation analysis. Results: Lipid values and liver function test results were similar for prav astatin and lovastatin treatment. Forty percent of patients achieved NCEP L DL-C goals before and after formulary conversion. There were no significant differences between pravastatin and lovastatin in QOL, medication toleranc e, and patient satisfaction. The projected cost savings from this therapeut ic interchange? was approximately $211,000 annually. Conclusion: Therapeutic interchange from pravastatin to lovastatin resulted in substantial cost savings. QOL, patient satisfaction, and achievement of NCEP LDL-C goals were maintained.